The Medicare ESRD program, established in 1973, instituted coverage for treatment of end stage kidney disease. 10,000 patients enrolled the first year. By 2000 there were 372,407 patients with chronic kidney disease (CKD) requiring dialysis or transplantation.
Over the last 30 years, nephrology nursing has evolved into a technologically advanced field of nursing that requires technical as well as clinical expertise in providing care for patients with CKD. The demand for nephrology nurses will only continue to grow as the number of patients with CKD is expected to be 661,330 by the year 2010.
Nephrology nursing is a specialized area of nursing that is directed towards individuals with kidney disease, and their families. Nephrology nurses function in many settings from bedside to the business side.
The nephrology nurse practices in the the following settings:
- CKD clinics
- Out-patient dialysis
- Home training
- In-patient dialysis
The nephrology nurse coordinates and provide staff training for dialysis personnel.
The nephrology nurse can be found in other settings such as:
- Medical device industry
- Pharmaceutical industry
Nephrology Nursing Practice:
The nephrology nurse adheres to all applicable regulations, statutes, and practice acts. The nephrology nurse is responsible for the care of pediatric and adult patients with kidney disease.
The nephrology nurse in the dialysis setting may be involved in the delivery of primary nursing care for patients with CKD. Responsibilities include:
- Nursing assessment
- Identification of risk factors
- Patient education
- Initiation of dialysis, patient and machine monitoring during dialysis, and termination of the dialysis procedure
- Home dialysis training
- Nursing care immediately prior to and following renal transplantation
The nephrology nurse may be involved in the delivery of secondary care, or case management of patients with CKD.Responsibilities include:
- Introducing treatment modalities to the patient and family
- Coordinating multidisciplinary care for the person with CKD
- Nursing intervention to prevent complications, decreasing the need for hospitalizations
- Assisting patients in achieving rehabilitative potential
The nephrology nurse may be involved in the tertiary care of the person with CKD which involves more complex care usually in an intensive care environment. Responsibilities may include:
- Acute dialysis, with care directed towards decreasing morbidity and mortality
- Coordinating care with multidisciplinary teams
The nephrology nurse may be involved in coordinating training for dialysis staff
The nephrology nurse must possess a knowledge base that includes the following:
- Anatomy and physiology of the kidney and urinary system
- Nephrology nursing process
- Teaching theory
- Psychosocial aspects of CKD
- Concepts and principles of dialysis and related therapies
- Circulatory access for hemodialysis.
- Concepts and principles of renal transplantation
12 months experience as a registered nurse in a medical-surgical unit or intensive care unit may be required prior to entering nephrology nursing.
Educational and Training Opportunities:
Additional training, including clinical as well as theory applications, is required for the entry level nephrology nurse in each specialized area. Training may be on the job (buddy system) or a formalized orientation program.
Certification in nephrology nursing is offered to those nurses meeting the necessary requirements to sit for the exam. For more information on organizations offering certification click on the following links:
- Nephrology Nursing Certification Commission (NNCC)
- Board of Nephrology Examiners - Nursing - Technology (BONENT)
Out-patient hemodialysis facilities customarily provide care Monday through Saturday, and the nephrology nurse may be required to work 8, 10, or 12 hour shifts. Acute hemodialysis and transplant units, operate 24 hours a day, 7 days a week.
Reporting relationships may vary depending on the setting. The nephrology nurse in the dialysis setting typically reports to the charge nurse or dialysis administrator.
What is The National Kidney Foundation and how does it help?
More than 20 million Americans-one in nine adults-has chronic kidney disease, and most don't even know it. More than 20 million others are at increased risk. The National Kidney Foundation, a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation. Through its 51 affiliates nationwide, the foundation conducts programs in research, professional education, patient and community services, public education and organ donation. The work of the National Kidney Foundation is funded by public donations.